Poor quality data on causes of stillbirth is a significant barrier to future prevention efforts. The proportion of unexplained stillbirth may be overestimated by 50% as a result of inadequate investigation, audit and classification. Our survey for The Lancet Ending Preventable Stillbirths Series indicates room for improvement in stillbirth investigation, with 50% of parents feeling that not everything possible had been done to find out why their baby died. Substandard care contributing to stillbirth is evident across Australia. High quality audit can reduce stillbirth but only if linked to practice improvement initiatives.
We have now updated the PSANZ Guideline on care around stillbirth and neonatal death to include the best available evidence for determining the causes of stillbirth and neonatal deaths through an evidence-based stillbirth investigation protocol, enhancements to the classification of causes and substandard care. Our aim is to implement and evaluate a package to promote best practice in stillbirth investigation. An on-line audit database developed as part of the Investigating the causes of stillbirth; a prospective cohort study examining use and effectiveness of a comprehensive investigation protocol will be refined to measure performance of the implementation strategies.
Expected outcomes: Acceptability and feasibility of the recommended audit process and improvement in quality of care, including stillbirth investigations, classification and audit and addressing substandard care factors; a reduction in unexplained stillbirth.